The URL can be used to link to this page

Home My WebLink About7939-z FO][~[ ]qO. 2 TOWN OF $OUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PER. iT (THIS PERMIT MUST BE KEPT ON THE P~,EMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) N? 7939 Z Permission is hereby granted to: ..... .,r.~t~..~..%~.~..,.~.. ~..z.~,~g ...c.,.o.~. ..................... ..... .1.~..7.... ~.~.. ~.' ~ .......................................... ...................... .~~ .................................... to, ...~.~..~.~...~:~:.g...~.~..~.~.=....~.r.z..~?..~.~ .o.~. .......................................................................... ,~t p~,~se~ ~ocoted ot ..... .C..~...?.7...~..~.~...~...Z...t.~.....~. .................................................................... Na%tit~ck pursuant to application dated .................... ~l~.~......t~ ................... , 19.~.~[.., and approved by the Building Inspector. ~ee ,..t~..,...o,.o.. .......... / ' Building Inspector TOWN OF SOUTHOI. D BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. ...... ............................... Approved i19'?''''~'''~'''' Application No. 2.~' ~ ~ ........................................ 1~.~.~7 Permit No..7..~....~....~.~.7. .............. APPLICATION FOR EIJILDIN~ PERMIT INSTRUCTIONS a This application must be completely filled in by typewriter o~ in ink and submitted in triplicate to the Buildir Inspector, with 3 sets of plans, accurate plot plan to scale. Fee according to schedule. b Plot plan showing Iocahon of lot and of buildings on premises, relahonsh~p to adjoining premises or public streets ~ areas, and gwing a detailed description of layout ofproperty must be drawn on the diagram which is part of this applicatio, c. The work covered by this application may not be commenced before ~ssuance of Building Permit. d Upon approval of this application, the Building Inspector wdl ~ssue a Budding Permit to the applicant. Such perm shall be kept on the premises available for inspection throughout the work. e No building shall be occupied or used in whole or in part for <:ny purpose whatever until a Certificate of Occupant shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the ~ssuance of a Building Permit pursuant to ti Building Zone Ordinance of the Town of Southold, Suffolk County, New York, and other applicable Laws, Ordinances, Regulations, for the construction of buildings, additions or aiterahons, or for removal or demolition, as herein describe The applicant agrees to comply with all applicable laws, ordinances, building code, housing code, and regulations, and admit authorized inspectors on premises and in buildings for necessary inspections. ........ ..... . ............................... (Address of applicant) State whether applicant is owner, lessee, agent, architect, eng,neer, general contractor, electrician, plumber Name of owner of premises . .?..I. ...... ~.. ...... ..~.~.....~ ...................................................................... If apl~hca~ a cq~'p~rate,/signature of du~,. authorized officer. Builder's License No ..................................................... Plumber's License No ................................................. Electrician's License No ............................................. Other Trade's License No .............................................. 1 Location of land on which p_roposed~work wdl be dckne M~p No ................................ Lot No .................... Street and Number ..t..~.~...~.. ..... .~L(.....~.?.~...~..~....~.~.~.~./-..//~.......~.~.~.. ....... ..~.!./.~.~.~..~../..~..~'. .......................... Municipality 2. State existing use and occupancy of premmes and re'ended use and occupancy of proposed construction' a Ex,siting use and occupancy ................................ .....~.~..~........ ~_ .......................................................................... b. Intended use and occupancy ....... ~.....~.~..j ............................................................................ 3. Nature of work (check which applicable) New Budding ................ Adder,on .............. Alteration ........ Repair ................. Removal .................Demoht~or. ................. Other Work ...~.C]/~'.C..~.__~......-. ............... ~, / ~ ,~- (Description) 4 Estimated Cost:'t"~'~1 ................................................. Fee ....................................................................................... (to be pa~d on filing th~s apphcat~on) 5. If dwelling, number of dwelhng un,ts ............ ./. .......... Number of dwelhng umts on each floor ......................... If garage, number of cars ................................................................................................................................ 6 If business, commercial or m~xed occupancy, specify nature and extent of each type of use ....................... 7. Dimensions of ex~stmg structures, if any' Front .......................... Rear ................................ Depth ................... Height ........................ Number of Stones .............................................................................................................. D~mens~ons of same structure with alterations or additions. Front ....................................Rear ..................... Depth .............................. Height ......................... Number of Stones ......................... 8 Dimensions of entire new construction: Front ............... . .............. Rear ............................ Depth ................... Height ................ Number of Stones ............................................................................................... 9 S~ze of lot Front ........................................................ Rear .......................................... Depth .............................. 10. Dale of Purchase ....................................................... Name of Former Owner ...................................................... 1 1. Zone or use d~stnct m which premises are situated ....................................................................................... 12 Does proposed construction violate any zoning law, ordinance or regulahon' . ...................................................... 13 Wdl lot be regraded ............................ Will excess fill be removed from premises. ( ) Yes ( ) No 14. Name of Owner of premises ................................................... Address ................................ Phone No ..................... Name of Architect .......................................... Address ................................ Phone No ..................... Name of Contractor ............................................. Address ................................ Phone No. .................... PLOT DIAGRAM Locate clearly and distinctly all buddings, whether ex~sting or proposed, and indicate all set-back d~mens~ons fro~ property hnes Gwe street and block number or description according to deed, and show street names and indicat ~vhether interior or corner lot COUNTY OF ....~P'~'M~..' ........ f'~'~. _ ~' ....................... ...(~.~../ ..... ./. ..... .~J..t.~..~. ...... ./r.~..~..h!~..?.~. '~',-~ being duly sworn, deposes and says that he ,s the applicar (Nan~ ~6f ~ndividual signing contracf) above named ~ He ,s the ....C~.~.(z~.C.~,, ..~-- .................... ] ................................................................................................ ~( on rac or, agent, corporate officer, etc ) of sa~d owner or owners, and ~s duly authorized to perform or have performed the said work and to make and fil th~s application, that all statements contained m this apphcat~on are true to the best of his knowledge and behef; an tk, a~ the work will be performed in the manner set forth in the apphcation filed therewith. ................ ~.../~day of ~'~'//'~' ., 1~. · / ........... .................... Notary Public,. ............ \! .... i~ig~ture of licant)